The DOI matches its Crossref record; 21 of the 22 references it cites were found in a registry or an index; none of the 8 sources its claims cite is checked for support yet.
Prevalence of Multimorbidity Among Adults Seen in Family Practice
Open accessAbstract
PURPOSE: There are few valid data that describe the extent of multimorbidity in primary care patients. The purpose of this study was to estimate its prevalence in family practice patients by counting the number of chronic medical conditions and using a measure that considers the severity of these conditions, the Cumulative Illness Rating Scale (CIRS). METHODS: The study was carried out in the Saguenay region (Québec, Canada) in 2003. The participation of adult patients from 21 family physicians was solicited during consecutive consultation periods. A research nurse reviewed medical records and extracted the data regarding chronic illnesses. For each chronic condition, a severity rating was determined in accordance with the CIRS scoring guidelines. RESULTS: The sample consisted of 320 men and 660 women. Overall, 9 of 10 patients had more than 1 chronic condition. The prevalence of having 2 or more medical conditions in the 18- to 44-year, 45- to 64-year, and 65-year and older age-groups was, respectively, 68%, 95%, and 99% among women and 72%, 89%, and 97% among men. The mean number of conditions and mean CIRS score also increased significantly with age. CONCLUSIONS: Whether measured by simply counting the number of conditions or using the CIRS, the prevalence of multimorbidity is quite high and increases significantly with age in both men and women. Patients with multimorbidity seen in family practice represent the rule rather than the exception.
Overview
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Written from the paper’s full text.
TL;DR
In a 2003 family practice sample in Quebec, multimorbidity was highly prevalent: 9 of 10 adults had more than 1 chronic condition, and prevalence increased with age. Whether measured by condition count or CIRS severity, multimorbidity was the rule rather than the exception.
Key findings
- Among 980 adult patients (320 men, 660 women), 9 of 10 had more than 1 chronic condition, and approximately 50% had 5 or more.
- Prevalence of 2 or more chronic conditions by age and sex was: women 68% (18–44 years), 95% (45–64 years), and 99% (65+ years); men 72%, 89%, and 97%, respectively.
- Mean CIRS scores increased significantly with age in both men and women (P < .001), rising from 6.3 to 13.1 in men and from 5.1 to 12.9 in women across the three age groups.
- The most common diagnoses were hypertension, hyperlipidemia, and rheumatologic diseases; the 3 most common diagnoses did not differ in frequency between men and women.
Methods
- Two-level survey in the Saguenay region of Quebec, Canada, in 2003. Of 119 eligible family physicians contacted, 27 volunteered and 21 participated after 6 dropped out; adult patients were recruited during consecutive consultation periods.
- Of 1,085 patients contacted, 980 (90.3%) agreed to participate. Research nurses reviewed medical records, extracted chronic diagnoses using the WHO definition of chronic conditions, and assigned severity scores using the CIRS-G; inter-rater reliability was ICC 0.91 (95% CI, 0.84–0.95).
- Analyses used SPSS version 8 with significance at 0.05; prevalence was reported by age and sex, means and medians were calculated for number of conditions and CIRS scores, CIRS means were compared with Kruskal-Wallis tests, proportions with chi-square tests, and 95% CIs were calculated. Clustering by physician was not accounted for because the intraclass correlation coefficient was very low (0.03).
Limitations
- The paper states that the data are only estimates of actual prevalence in the population consulting family physicians; a random sample of each physician’s patients would have been required for more precise measurement. The sample was probably overrepresented by patients who see their physicians often because of multiple conditions, volunteer practices may have introduced unknown biases, and duration of the doctor-patient relationship was not recorded or controlled.
- The paper also states that generalizability may be reduced by the limited number of participating physicians, a female-to-male ratio exceeding that of the general population, possible recruitment bias, and exclusion criteria (pregnancy, illiteracy, or lack of decision-making capacity). Participating and nonparticipating physicians seemed comparable, but few characteristics were compared. Socioeconomic status was not assessed.
- Evident from the text: the profile of patients who refused participation could not be determined, so refusal bias cannot be quantified.
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Claims the paper makes
18 Own result · 11 Own interpretation · 9 Own method · 6 Not checked yet · 2 No basis given
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“approximately 50% had 5 or more.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > RESULTS
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A sex difference was found only in the number of conditions in the intermediate age-group.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Overall, 9 of 10 patients had more than 1 chronic condition.”
- Also stated in: § RESULTS · plain
“Nine of 10 had more than 1 chronic condition”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > Abstract
plainn = 10- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § RESULTS · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the proportion of patients with a high CIRS score rises with age in both men (P <.001) and women (P <.001).”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > RESULTS
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Nearly 50% of the patients between 45 and 64 years of age had 5 or more chronic conditions.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The mean number of conditions and mean CIRS score also increased signifi cantly with age.”
- Also stated in: § RESULTS · plain
“Both of these variables increase with age in men (P <.001) and women (P <.001).”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § RESULTS · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The prevalence of having 2 or more medical conditions in the 18-to 44-year, 45-to 64-year, and 65-year and older age-groups was, respectively, 68%, 95%, and 99% among women and 72%, 89%, and 97% among men.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > Abstract
plainn = 320- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The mean number of conditions and mean CIRS score also increased signifi cantly with age.”
- Also stated in: § RESULTS · plain
“Both of these variables increase with age in men (P <.001) and women (P <.001).”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § RESULTS · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The prevalence of having 2 or more medical conditions in the 18-to 44-year, 45-to 64-year, and 65-year and older age-groups was, respectively, 68%, 95%, and 99% among women and 72%, 89%, and 97% among men.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > Abstract
plainn = 660- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The prevalence of having 2 or more medical conditions in the 18-to 44-year, 45-to 64-year, and 65-year and older age-groups was, respectively, 68%, 95%, and 99% among women and 72%, 89%, and 97% among men.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > Abstract
plainn = 320- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Probably not a substantial claim. 17
- It may state two separate claims as one. 9
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The sample consisted of 320 men and 660 women.”
- Also stated in: § RESULTS · plain
“Of these, 980 (90.3%) agreed to participate: 320 men and 660 women.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > Abstract
plainn = 320- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Also stated in: § RESULTS · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the most common diagnoses were hypertension, hyperlipidemia, and rheumatologic diseases.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The 3 most common diagnoses did not differ in frequency between men and women.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“That the practices were volunteer may also have introduced unknown biases.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > Limitations
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Whether measured by simply counting the number of conditions or using the CIRS, the prevalence of multimorbidity is quite high and increases signifi cantly with age in both men and women.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > Abstract
plaindirectn = 320- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Even so, the consequences of excluding the small minority of patients who were pregnant, illiterate, or lacked decision-making capacity should have been negligible.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > Limitations
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Moreover, the duration of doctorpatient relationship could not be controlled for because it was not recorded in this study.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > Limitations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“As there is no cutoff score above which one can conclude that multimorbidity is present, various cutoff points were used in this study.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > Scoring and Validation
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Such a high prevalence of multiple chronic conditions calls into question the very organization of our health services.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The results of this study offer additional support to the current trend in family medicine residency programs to concentrate on patients with multimorbidity.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
In the paper
“In terms of specialized care, the Saguenay region is similar to the Canadian average, with 9.0 medical specialists per 10,000 people.15 This fi gure represents only 60% of its estimated staffi ng needs.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > Study Region
What the sources say
- Not checked yetcites [15]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A score 10 or higher seems adequate for discriminating between younger and older patients”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > DISCUSSION
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Other factors that may reduce the generalizability of our results include the limited number of participating physicians, a female-to-male ratio exceeding that of the general population, and possible recruitment bias.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > Limitations
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Information about chronic medical conditions is more likely to be found in medical records than in other data sources, such as administrative data or surveys; therefore, a review of medical records seems to be a better way of estimating the prevalence of multimorbidity and may produce higher estimates.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > DISCUSSION
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Another factor that could help explain the high prevalence of multimorbidity observed here is the relative lack of medical specialists in the Saguenay region.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > DISCUSSION
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Although the CIRS does not have a cutoff score to determine multimorbidity, the cutoff scores of 5 and 10 used in this study indicate disease in at least 2 or 3 systems and 4 or 5 systems, respectively.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > DISCUSSION
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“The socioeconomic status (SES) of residents is comparable to that of those in the rest of Canada, except for a higher unemployment rate (12% vs 8% in 2001).”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > Study Region
What the sources say
- Not checked yetcites [14]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The very low intraclass correlation coeffi cient (0.03) justifi es the analysis of morbidity at the patient level only.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > Statistical Analyses
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The ratio of general practitioners to patients (8.7 per 10,000) is a little less than the average 9.5 for Canada.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > Study Region
What the sources say
- Not checked yetcites [15]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Interventions that suit patients with a single disease may not be appropriate for patients with many comorbid conditions.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > DISCUSSION
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The wide extent of multimorbidity also strongly supports the development of innovative interventions focused on collaborative practices to better share the burden.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > DISCUSSION
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
In the paper
“Nevertheless, the ratio of medical specialists in the Saguenay region (9 per 10,000 people) is similar to the Canadian average 14 and midway between that of large urban centers and rural regions.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > DISCUSSION
What the sources say
- Not checked yetcites [14]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The CIRS has undergone several validation studies.11,18,19”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > Scoring and Validation
What the sources say
- Not checked yetcites [11]
- Not checked yetcites [18]
- Not checked yetcites [19]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper relies on this without support.
Patients who refused to participate did not differ systematically from participants in a way that would affect prevalence estimates.
“The profi le of the patients who refused to participate could not be determined.”
The paper relies on this without support.
Medical records accurately and completely reflect patients' chronic conditions.
“A research nurse reviewed medical records and extracted the data regarding chronic illnesses.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“In the UK, for example, recent estimates suggest that one in six patients have more than one chronic condition, and these patients account for approximately one-third of all general practice consultations.13”
From Artificial intelligence: opportunities and implications for the health workforce (2020) · cites this paper as [13]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > DISCUSSION
“Although the CIRS does not have a cutoff score to determine multimorbidity, the cutoff scores of 5 and 10 used in this study indicate disease in at least 2 or 3 systems and 4 or 5 systems, respectively.”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > Scoring and Validation
“The CIRS uses a scoring system that includes 14 anatomical domains; a scale ranging from 0 (no condition in this domain) to 4 (extremely serious condition) is used to determine a severity score for each domain.”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > Physician Eligibility and Characteristics
“18-14 y: 2.8 45-64 y: 4.6 65+ y: 6.5”
§ Prevalence of Multimorbidity Among Adults Seen in Family Practice > Physician Eligibility and Characteristics
“18-44 y: 69.3 45-64 y: 92.8 65+ y: 98.7”
Citations
Cites
Improving Primary Care for Patients With Chronic Illness
Bodenheimer, T. (2002) · JAMA · doi:10.1001/jama.288.14.1775 · Cited by 2,961 · cited 2×
“5 or more 19 (10-31) 18 (13-25) 42 (34-50) 51 (46-57) 74 (65-81) 77 (71-83)”
Improving Primary Care for Patients With Chronic Illness: The Chronic Care Model, Part 2
Bodenheimer, T., Wagner, E. H., & Grumbach, K. (2002) · JAMA · doi:10.1001/jama.288.15.1909 · Cited by 2,413
CUMULATIVE ILLNESS RATING SCALE
Linn, B. S., Linn, M. W., & Gurel, L. (1968) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1968.tb02103.x · Cited by 2,332 · cited 2×
“5 or more 19 (10-31) 18 (13-25) 42 (34-50) 51 (46-57) 74 (65-81) 77 (71-83)”
Prevalence, Expenditures, and Complications of Multiple Chronic Conditions in the Elderly
Wolff, J. L., Starfield, B. H., & Anderson, G. F. (2002) · Archives of Internal Medicine · doi:10.1001/archinte.162.20.2269 · Cited by 2,237
Miller, M. D., Paradis, C. F., Houck, P. R., Mazumdar, S., Stack, J. A., Rifai, A. H., Mulsant, B., & Reynolds, C. F. (1992) · Psychiatry Research · doi:10.1016/0165-1781(92)90005-n · Cited by 1,990 · cited 2×
“5 or more 19 (10-31) 18 (13-25) 42 (34-50) 51 (46-57) 74 (65-81) 77 (71-83)”
How to measure comorbiditya critical review of available methods
DEGROOT, V, BECKERMAN, H., LANKHORST, G., & BOUTER, L. (2003) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(02)00585-1 · Cited by 1,757
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Persons With Chronic Conditions
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Comorbidity or multimorbidity: what's in a name? A review of literature
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Descriptions of Barriers to Self-Care by Persons with Comorbid Chronic Diseases
Bayliss, E. A. (2003) · The Annals of Family Medicine · doi:10.1370/afm.4 · Cited by 537 · cited 3×
“5 or more 19 (10-31) 18 (13-25) 42 (34-50) 51 (46-57) 74 (65-81) 77 (71-83)”
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Barnett, K., Mercer, S. W., Norbury, M., Watt, G., Wyke, S., & Guthrie, B. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60240-2 · Cited by 6,972
Aging with multimorbidity: A systematic review of the literature
Marengoni, A., Angleman, S., Melis, R., Mangialasche, F., Karp, A., Garmen, A., Meinow, B., & Fratiglioni, L. (2011) · Ageing Research Reviews · doi:10.1016/j.arr.2011.03.003 · Cited by 3,092
“Fortin et al. (2005) Canada residential N = 980 (18+ years) General practitioner records Multimorbidity defined as 2+ co-existing chronic diseases 98% in 65+ years”
BackgroundSkou, S. T., Mair, F. S., Fortin, M., Guthrie, B., Nunes, B. P., Miranda, J. J., Boyd, C. M., Pati, S., Mtenga, S., & Smith, S. M. (2022) · Nature Reviews Disease Primers · doi:10.1038/s41572-022-00376-4 · Cited by 1,499
Self-citationBig Data In Health Care: Using Analytics To Identify And Manage High-Risk And High-Cost Patients
Bates, D. W., Saria, S., Ohno-Machado, L., Shah, A., & Escobar, G. (2014) · Health Affairs · doi:10.1377/hlthaff.2014.0041 · Cited by 1,235
A Systematic Review of Prevalence Studies on Multimorbidity: Toward a More Uniform Methodology
Fortin, M., Stewart, M., Poitras, M.-È., Almirall, J., & Maddocks, H. L. (2012) · The Annals of Family Medicine · doi:10.1370/afm.1337 · Cited by 1,131
Self-citationViolan, C., Foguet-Boreu, Q., Flores-Mateo, G., Salisbury, C., Blom, J., Freitag, M., Glynn, L., Muth, C., & Valderas, J. M. (2014) · PLoS ONE · doi:10.1371/journal.pone.0102149 · Cited by 1,125
“Age was the most frequently studied determinant of multimorbidity [16,18,20,22,25,27,30,32,34,37,41,47,51,52].”
BackgroundResultInfluentialSmith, S. M., Wallace, E., O’Dowd, T., & Fortin, M. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006560.pub3 · Cited by 921
Self-citationEpidemiology and impact of multimorbidity in primary care: a retrospective cohort study
Salisbury, C., Johnson, L., Purdy, S., Valderas, J. M., & Montgomery, A. A. (2011) · British Journal of General Practice · doi:10.3399/bjgp11x548929 · Cited by 883
Review: Health Care Utilization and Costs of Elderly Persons With Multiple Chronic Conditions
Lehnert, T., Heider, D., Leicht, H., Heinrich, S., Corrieri, S., Luppa, M., Riedel-Heller, S. G., & König, H. (2011) · Medical Care Research and Review · doi:10.1177/1077558711399580 · Cited by 753
Managing patients with multimorbidity in primary care
Wallace, E., Salisbury, C., Guthrie, B., Lewis, C., Fahey, T. P., & Smith, S. M. (2015) · BMJ · doi:10.1136/bmj.h176 · Cited by 752
Smith, S. M., Soubhi, H., Fortin, M., Hudon, C., & O'Dowd, T. C. (2012) · BMJ · doi:10.1136/bmj.e5205 · Cited by 744
Self-citationDiederichs, C., Berger, K., & Bartels, D. B. (2011) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/glq208 · Cited by 693
Boyd, C. M., & Fortin, M. (2010) · Public health reviews · doi:10.1007/bf03391611 · Cited by 701
Self-citationThe prevalence of multimorbidity in primary care and its effect on health care utilization and cost
Glynn, L. G., Valderas, J. M., Healy, P., Burke, E., Newell, J., Gillespie, P., & Murphy, A. W. (2011) · Family Practice · doi:10.1093/fampra/cmr013 · Cited by 669
Huntley, A. L., Johnson, R., Purdy, S., Valderas, J. M., & Salisbury, C. (2012) · The Annals of Family Medicine · doi:10.1370/afm.1363 · Cited by 619
Nguyen, H., Manolova, G., Daskalopoulou, C., Vitoratou, S., Prince, M. J., & Prina, M. A. (2019) · Journal of Comorbidity · doi:10.1177/2235042x19870934 · Cited by 610
“Fortin et al.(96) reported a much higher prevalence of multimorbidity when using the Cumulative Illness Rating Scale, compared with the prevalence measured by disease count in other studies.”
ResultThe increasing burden and complexity of multimorbidity
Kone, A. P., Bronskill, S. E., Gruneir, A., Calzavara, A. J., Thavorn, K., Petrosyan, Y., Maxwell, C. J., Bai, Y., & Wodchis, W. P. (2015) · BMC Public Health · doi:10.1186/s12889-015-1733-2 · Cited by 598
“Moreover, when using an open list, only a few and specific conditions contribute the most to the prevalence of multimorbidity [13,14,24,25].”
BackgroundInfluentialRelationship Between Multimorbidity and Health-Related Quality of Life of Patients in Primary Care
Fortin, M., Bravo, G., Hudon, C., Lapointe, L., Almirall, J., Dubois, M., & Vanasse, A. (2006) · Quality of Life Research · doi:10.1007/s11136-005-8661-z · Cited by 615
“Details of the methods and sampling strategies used are described in the publication of the results of the first phase of this project [4].”
BackgroundMethodSelf-citationSalvi, F., Miller, M. D., Grilli, A., Giorgi, R., Towers, A. L., Morichi, V., Spazzafumo, L., Mancinelli, L., Espinosa, E., RAPPELLI, A., et al. (2008) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2008.01935.x · Cited by 603
Ward, B. W., & Schiller, J. S. (2013) · Preventing Chronic Disease · doi:10.5888/pcd10.120203 · Cited by 578
The Problem of Fragmentation and the Need for Integrative Solutions
Stange, K. C. (2009) · The Annals of Family Medicine · doi:10.1370/afm.971 · Cited by 571
Fabbri, E., Zoli, M., González‐Freire, M., Salive, M. E., Studenski, S. A., & Ferrucci, L. (2015) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2015.03.013 · Cited by 589
Multimorbidity's many challenges
Fortin, M., Soubhi, H., Hudon, C., Bayliss, E. A., & van den Akker, M. (2007) · BMJ · doi:10.1136/bmj.39201.463819.2c · Cited by 531
Self-citationDefining and Measuring the Patient-Centered Medical Home
Stange, K. C., Nutting, P. A., Miller, W. L., Jaén, C. R., Crabtree, B. F., Flocke, S. A., & Gill, J. M. (2010) · Journal of General Internal Medicine · doi:10.1007/s11606-010-1291-3 · Cited by 516
The Medical Home: Growing Evidence to Support a New Approach to Primary Care
Rosenthal, T. C. (2008) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2008.05.070287 · Cited by 508
Multimorbidity in primary care: prevalence and trend over the last 20 years
Uijen, A. A., & van de Lisdonk, E. H. (2008) · European Journal of General Practice · doi:10.1080/13814780802436093 · Cited by 505
“studied a sample of 980 adults in Canada (12).”
BackgroundMethods for identifying 30 chronic conditions: application to administrative data
Tonelli, M., Wiebe, N., Fortin, M., Guthrie, B., Hemmelgarn, B. R., James, M. T., Klarenbach, S. W., Lewanczuk, R., Manns, B. J., Ronksley, P., et al. (2016) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-015-0155-5 · Cited by 400
“Multiple prior studies have ascertained the presence of various chronic conditions in the context of assessing multimorbidity [4,7,22-34].”
BackgroundSelf-citationMultimorbidity and functional decline in community-dwelling adults: a systematic review
Ryan, Á., Wallace, E., O’Hara, P. V., & Smith, S. M. (2015) · Health and Quality of Life Outcomes · doi:10.1186/s12955-015-0355-9 · Cited by 411
“Participants included adults (>18 years) with multimorbidity defined as the presence of two or more chronic medical conditions in an individual [1].”
BackgroundThe excess costs of depression: a systematic review and meta-analysis
König, H., König, H.-H., & Konnopka, A. (2019) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796019000180 · Cited by 411
“Another explanation for a decreasing tendency with age could be that comorbidities increase with age, resulting in lower relative excess costs between depressed and nondepressed (Fortin et al., 2005; Schäfer et al., 2012).”
Prevalence and patterns of multimorbidity in Australia
Britt, H. C., Harrison, C. M., Miller, G. C., & Knox, S. A. (2008) · Medical Journal of Australia · doi:10.5694/j.1326-5377.2008.tb01919.x · Cited by 402
Matthew‐Maich, N., Harris, L., Ploeg, J., Markle‐Reid, M., Valaitis, R. K., Ibrahim, S., Gafni, A., & Isaacs, S. (2016) · JMIR mhealth and uhealth · doi:10.2196/mhealth.5127 · Cited by 409
“It is estimated that approximately one in four older adults have two or more chronic conditions and half of older adults (≥ 65 years) have three or more (ie, heart disease, diabetes, arthritis, chronic lower respiratory tract disease, stroke, chronic obstructive pulmonary disease [COPD], dementia, and hypertension) [4…”
Schäfer, I., von Leitner, E.-C., Schön, G., Koller, D., Hansen, H., Kolonko, T., Kaduszkiewicz, H., Wegscheider, K., Glaeske, G., & van den Bussche, H. (2010) · PLoS ONE · doi:10.1371/journal.pone.0015941 · Cited by 405
“76% of the patients in general practice have three or more chronic conditions [2].”
Backgroundvan den Bussche, H., Koller, D., Kolonko, T., Hansen, H., Wegscheider, K., Glaeske, G., von Leitner, E.-C., Schäfer, I., & Schön, G. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-101 · Cited by 346
“In other studies, however, larger gender differences were found, usually showing a higher prevalence in women [10], but occasionally also in men [5,21].”
BackgroundMethodHarrison, C. M., Britt, H. C., Miller, G. C., & Henderson, J. (2014) · BMJ Open · doi:10.1136/bmjopen-2013-004694 · Cited by 343
Fortin, M. (2006) · The Annals of Family Medicine · doi:10.1370/afm.516 · Cited by 341
Self-citationMultimorbidity: redesigning health care for people who use it
Salisbury, C. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60482-6 · Cited by 326
Prevalence and patterns of chronic disease multimorbidity and associated determinants in Canada
Roberts, K. C., Rao, D. P., Bennett, T.-L., Loukine, L., & Jayaraman, G. (2015) · Health Promotion and Chronic Disease Prevention in Canada · doi:10.24095/hpcdp.35.6.01 · Cited by 308
Psychological Distress and Multimorbidity in Primary Care
Fortin, M. (2006) · The Annals of Family Medicine · doi:10.1370/afm.528 · Cited by 308
Self-citationSchäfer, I., Hansen, H., Schön, G., Höfels, S., Altiner, A., Dahlhaus, A., Gensichen, J., Riedel-Heller, S., Weyerer, S., Blank, W. A., et al. (2012) · BMC Health Services Research · doi:10.1186/1472-6963-12-89 · Cited by 296
“We defined multimorbidity as presence of three or more chronic conditions in order to avoid that almost every patient aged 65 or more is defined as multimorbid [6].”
Multimorbidity - not just an older person's issue. Results from an Australian biomedical study
Taylor, A. W., Price, K., Gill, T. K., Adams, R., Pilkington, R. M., Carrangis, N., Shi, Z., & WILSON, D. H. (2010) · BMC Public Health · doi:10.1186/1471-2458-10-718 · Cited by 284
“Prevalence estimates for multimorbidity range from 35% to 80% [2,10-15].”
BackgroundInfluentialMauksch, L. B. (2008) · Archives of Internal Medicine · doi:10.1001/archinte.168.13.1387 · Cited by 299
Prevalence estimates of multimorbidity: a comparative study of two sources
Fortin, M., Hudon, C., Haggerty, J. L., van den Akker, M., & Almirall, J. (2010) · BMC Health Services Research · doi:10.1186/1472-6963-10-111 · Cited by 286
“A recent publication [14] in which prevalence estimates of multimorbidity were calculated using data obtained in 2005 from the general population of the province of Quebec, Canada, allowed us to make a comparison with prevalence estimates of multimorbidity using data from a 2003 family practice-based study [13] in the…”
InfluentialSelf-citationWang, H., Wang, J. J., Wong, S. Y. S., Wong, M. C. S., Li, F. J., Wang, P. X., Zhou, Z. H., Zhu, C., Griffiths, S. M., & Mercer, S. W. (2014) · BMC Medicine · doi:10.1186/s12916-014-0188-0 · Cited by 285
“Studies in western countries show that many people living with chronic disease have two or more (multimorbidity) [3].”
BackgroundMethodImproving responsiveness of health systems to non-communicable diseases
Atun, R. A., Jaffar, S. S., Nishtar, S., Knaul, F. M., Barreto, M. L., Nyirenda, M., Banatvala, N., & Piot, P. K. (2013) · The Lancet · doi:10.1016/s0140-6736(13)60063-x · Cited by 286
Multimorbidity Patterns in Primary Care: Interactions among Chronic Diseases Using Factor Analysis
Prados‐Torres, A., Poblador‐Plou, B., Calderón‐Larrañaga, A., Gimeno-Feliú, L. A., González‐Rubio, F., Poncel-Falcó, A., Sicras‐Mainar, A., & Nalvaiz, J. T. A. (2012) · PLoS ONE · doi:10.1371/journal.pone.0032190 · Cited by 280
“In fact, most studies to date are based on counts of the number of health problems, or the proportion of people with pairs of conditions [13,14].”
BackgroundPayne, R., Abel, G., Guthrie, B., & Mercer, S. W. (2013) · Canadian Medical Association Journal · doi:10.1503/cmaj.121349 · Cited by 282
“Multimorbidity — usually defined as the presence of more than 1 longterm disorder — is becoming the norm rather than the exception as populations age.(1,2) A recent study found that most people older than 65 years of age had multimorbidity, and the mean number of comorbidities per person increased with age;(1) however…”
BackgroundRyan, R. E., Santesso, N., Lowe, D., Hill, S., Grimshaw, J. M., Prictor, M., Kaufman, C., Cowie, G., & Taylor, M. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007768.pub3 · Cited by 273
Lee, J. T., Hamid, F., Pati, S., Atun, R. A., & Millett, C. J. (2015) · PLoS ONE · doi:10.1371/journal.pone.0127199 · Cited by 279
“[46] Third, we assessed multimorbidity by counting the number of NCDs without applying any weights to account for severity of conditions.[7] Fourth, the cross-sectional study design limits causal interpretation of our findings.”
MethodMultimorbidity prevalence and patterns across socioeconomic determinants: a cross-sectional survey
Agborsangaya, C. B., Lau, D., Lahtinen, M., Cooke, T., & Johnson, J. A. (2012) · BMC Public Health · doi:10.1186/1471-2458-12-201 · Cited by 269
“Disease status was based on self-reports, and multimorbidity was defined as the presence of two or more chronic conditions [1,15].”
BackgroundInfluentialComorbidity prevalence among cancer patients: a population-based cohort study of four cancers
Fowler, H., Belot, A., Ellis, L., Maringe, C., Luque-Fernández, M. Á., Njagi, E. N., Navani, N., Sarfati, D., & Rachet, B. (2020) · BMC Cancer · doi:10.1186/s12885-019-6472-9 · Cited by 285
Economic burden of multimorbidity among older adults: impact on healthcare and societal costs
Picco, L., Achilla, E., Abdin, E., Chong, S. A., Vaingankar, J. A., McCrone, P., Chua, H. C., Heng, D., Magadi, H., Ng, L. L., et al. (2016) · BMC Health Services Research · doi:10.1186/s12913-016-1421-7 · Cited by 266
“Multimorbidity is progressively more common with age [5, 13] and is associated with socio-demographic correlates such as gender and socio-economic status [10, 14] as well as reduced functional status [15], poorer quality of life [16] and higher risk of care dependency [17].”
BackgroundLandi, F., Liperoti, R., Russo, A., Capoluongo, E., Barillaro, C., Pahor, M., Bernabei, R., & Onder, G. (2010) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2009.09.007 · Cited by 258
“4 in the oldest [16].”
Associations of frailty with health care costs – results of the ESTHER cohort study
Bock, J., König, H., Brenner, H., Haefeli, W. E., Quinzler, R., Matschinger, H., Saum, K.-U., Schöttker, B., & Heider, D. (2016) · BMC Health Services Research · doi:10.1186/s12913-016-1360-3 · Cited by 260
“Old age is accompanied by many geriatric phenomena that include, for example, multiple chronic conditions, also referred to as ‘multimorbidity’ [2, 3].”
BackgroundMultimorbidity and quality of life: a closer look
Fortin, M., Dubois, M., Hudon, C., Soubhi, H., & Almirall, J. (2007) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-5-52 · Cited by 257
Self-citationPrevalence of comorbidity of chronic diseases in Australia
Caughey, G. E., Vitry, A. I., Gilbert, A. L., & Roughead, E. E. (2008) · BMC Public Health · doi:10.1186/1471-2458-8-221 · Cited by 256
“A similar disparity between the prevalence of multimorbidity in the general population of Canada and the number of research publications [13], was recently reported by Fortin and colleagues where the majority of studies focused on the epidemiology of multimorbidity or its effects on quality of life and physical functi…”
ResultMultimorbidity and comorbidity in the Dutch population – data from general practices
van Oostrom, S. H., Picavet, H. S. J., van Gelder, B. M., Lemmens, L. C., Hoeymans, N., van Dijk, C. E., Verheij, R. A., Schellevis, F., & Baan, C. A. (2012) · BMC Public Health · doi:10.1186/1471-2458-12-715 · Cited by 253
“First, multimorbidity being rather the rule than the exception and prevalences increasing with age but also found at younger age [3-8,25-27].”
BackgroundReste, J. Y. L., Nabbé, P., Manceau, B., Lygidakis, C., Doerr, C., Lingner, H., Czachowski, S., Muñoz, M. Á., Argyriadou, S., Clavería, A., et al. (2013) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2013.01.001 · Cited by 243
Roshanov, P. S., Misra, S., Gerstein, H. C., Garg, A. X., Sebaldt, R. J., Mackay, J. A., Weise-Kelly, L., Navarro, T., Wilczynski, N. L., Haynes, R. B., et al. (2011) · Implementation Science · doi:10.1186/1748-5908-6-92 · Cited by 236
“For the many patients with multiple co-morbidities [1], overlapping or diverging care plans may further complicate these processes.”
BackgroundSmith, S. M., Wallace, E., O’Dowd, T., & Fortin, M. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006560.pub4 · Cited by 240
Self-citationPatientsʼ Perceptions of Sharing in Decisions
Légaré, F., Turcotte, S., Stacey, D., Ratté, S., Kryworuchko, J., & Graham, I. D. (2012) · Patient · doi:10.2165/11592180-000000000-00000 · Cited by 229
Major Health Risks in Aging Persons With Intellectual Disabilities: An Overview of Recent Studies
Haveman, M. J., Heller, T., Lee, L. M. Y., Maaskant, M. A., Shooshtari, S., & Strydom, A. (2010) · Journal of Policy and Practice in Intellectual Disabilities · doi:10.1111/j.1741-1130.2010.00248.x · Cited by 221
What are the effective elements in patient-centered and multimorbidity care? A scoping review
Poitras, M.-E., Maltais, M.-E., Bestard-Denommé, L., Stewart, M., & Fortin, M. (2018) · BMC Health Services Research · doi:10.1186/s12913-018-3213-8 · Cited by 219
“Background Patients with multimorbidity represent a significant portion of the primary healthcare population [1].”
BackgroundSelf-citationA Core Outcome Set for Multimorbidity Research (COSmm)
Smith, S. M., Wallace, E., Salisbury, C., Sasseville, M., Bayliss, E. A., & Fortin, M. (2018) · The Annals of Family Medicine · doi:10.1370/afm.2178 · Cited by 218
“We had 3 specific objectives: (1) to identify outcomes and outcome metrics that had previously been used in intervention studies for multimorbidity; (2) to develop a consensus-based set of core outcomes for intervention studies in multimorbidity; and (3) to describe related outcome metrics used for outcomes for multim…”
BackgroundSelf-citationCumulative Illness Rating Scale was a reliable and valid index in a family practice context
Hudon, C., Fortin, M., & Vanasse, A. (2005) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2004.10.017 · Cited by 219
Self-citationGadermann, A. M., Alonso, J., Vilagut, G., Zaslavsky, A. M., & Kessler, R. C. (2012) · Depression and Anxiety · doi:10.1002/da.21924 · Cited by 210
“In line with previous studies, our results show that comorbidity is the norm among chronic conditions[7, 8, 42, 43] and that the vast majority of the mental and physical disorders considered here are associated with decrements in perceived health.”
ResultKadam, U. T., & Croft, P. R. (2007) · Family Practice · doi:10.1093/fampra/cmm049 · Cited by 209
Sinnige, J., Braspenning, J. C. C., Schellevis, F., Stirbu-Wagner, I., Westert, G. P., & Korevaar, J. C. (2013) · PLoS ONE · doi:10.1371/journal.pone.0079641 · Cited by 218
“First, differences in the population under study may affect the prevalence of multimorbidity and related disease clusters, like age, income, or ethnicity[47-52].”
BackgroundMcLean, G., Gunn, J. M., Wyke, S., Guthrie, B., Watt, G. C. M., Blane, D., & Mercer, S. W. (2014) · British Journal of General Practice · doi:10.3399/bjgp14x680545 · Cited by 209
A Scoping Review and Thematic Classification of Patient Complexity: Offering a Unifying Framework
Schaink, A. K., Kuluski, K., Lyons, R., Fortin, M., Jadad, A. R., Upshur, R. E. G., & Wodchis, W. P. (2012) · Journal of Comorbidity · doi:10.15256/joc.2012.2.15 · Cited by 218
Self-citationArtificial intelligence: opportunities and implications for the health workforce
Hazarika, I. (2020) · International Health · doi:10.1093/inthealth/ihaa007 · Cited by 203
Costs of multimorbidity: a systematic review and meta-analyses
Tran, P. B., Kazibwe, J., Nikolaidis, G. F., Linnosmaa, I., Rijken, M., & van Olmen, J. (2022) · BMC Medicine · doi:10.1186/s12916-022-02427-9 · Cited by 208
Pati, S., Agrawal, S., Swain, S., Lee, J. T., Vellakkal, S., Hussain, M. A., & Millett, C. J. (2014) · BMC Health Services Research · doi:10.1186/1472-6963-14-451 · Cited by 197
“Another study undertaken in a family practice settings in Canada has reported nine out of ten patients to have more than one chronic condition [22].”
BackgroundResultThreads and Yarns: Weaving the Tapestry of Comorbidity
Starfield, B. H. (2006) · The Annals of Family Medicine · doi:10.1370/afm.524 · Cited by 194
Smith, S. M., Soubhi, H., Fortin, M., Hudon, C., & O’Dowd, T. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006560.pub2 · Cited by 196
Self-citationThe Association Between Multimorbidity and Quality of Life, Health Status and Functional Disability
Williams, J. S., & Egede, L. E. (2016) · The American Journal of the Medical Sciences · doi:10.1016/j.amjms.2016.03.004 · Cited by 194
“org comorbid conditions.(5) It is postulated that this number would increase to approximately 81 million by 2020.”
BackgroundMultimorbidity in primary care: a systematic review of prospective cohort studies
France, E. F., Wyke, S., Gunn, J. M., Mair, F. S., McLean, G., & Mercer, S. W. (2012) · British Journal of General Practice · doi:10.3399/bjgp12x636146 · Cited by 190
Monterde, D., Vela, E., & Clèries, M. (2016) · Atención Primaria · doi:10.1016/j.aprim.2016.06.003 · Cited by 183
Fortin, M., Hudon, C., Dubois, M.-F., Almirall, J., Lapointe, L., & Soubhi, H. (2005) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-3-74 · Cited by 184
“Details of the sampling are described elsewhere [17].”
Self-citationGensichen, J., von Korff, M., Peitz, M., Muth, C., Beyer, M., Güthlin, C., Torge, M., Petersen, J. J., Rosemann, T., König, J., et al. (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-151-6-200909150-00001 · Cited by 181
Larsen, F. B., Pedersen, M. H., Friis, K., Glümer, C., & Lasgaard, M. (2017) · PLoS ONE · doi:10.1371/journal.pone.0169426 · Cited by 180
Social determinants of multimorbidity patterns: A systematic review
Álvarez‐Gálvez, J., Ortega‐Martin, E., Carretero-Bravo, J., Pérez-Muñoz, C., Suárez-Lledó, V., & Ramos-Fiol, B. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1081518 · Cited by 183
A Systematic Review of Cost-of-Illness Studies of Multimorbidity
Wang, L., Si, L., Cocker, F., Palmer, A. J., & Sanderson, K. (2018) · Applied Health Economics and Health Policy · doi:10.1007/s40258-017-0346-6 · Cited by 178
Multimorbidity and out-of-pocket expenditure on medicines: a systematic review
Sum, G., Hone, T., Atun, R. A., Millett, C. J., Suhrcke, M., Mahal, A. S., Koh, G. C., & Lee, J. T. (2018) · BMJ Global Health · doi:10.1136/bmjgh-2017-000505 · Cited by 186
“The literature shows a trend that multimorbidity in family practice is now the norm rather than the exception.(41) Clinicians need to consider the financial burden incurred by patients with multimorbidity due to polypharmacy, and the risks of non-adherence and foregoing medicines as coping strategies.”
BackgroundHudon, C., Fortin, M., Haggerty, J. L., Loignon, C., Lambert, M., & Poitras, M.-È. (2012) · Patient Education and Counseling · doi:10.1016/j.pec.2012.01.009 · Cited by 177
“For instance, considering the significant prevalence of multimorbidity in primary care practices [54–56], experience of care should extend beyond present experience to capture previous experiences of care [22].”
BackgroundSelf-citationThe Prevalence of Chronic Diseases and Multimorbidity in Primary Care Practice: A PPRNet Report
Ornstein, S. M., Nietert, P. J., Jenkins, R., & Litvin, C. B. (2013) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2013.05.130012 · Cited by 182
“Our findings on the prevalence of multimorbidity are comparable to earlier primary care studies from the Netherlands(27) and Canada.(28) Figure 1.”
ResultO’Brien, R., Wyke, S., Guthrie, B., Watt, G. C. M., & Mercer, S. W. (2010) · Chronic Illness · doi:10.1177/1742395310382461 · Cited by 176
How do common chronic conditions affect health-related quality of life?
Heyworth, I. T., Hazell, M. L., Linehan, M. F., & Frank, T. L. (2009) · British Journal of General Practice · doi:10.3399/bjgp09x453990 · Cited by 172
Katikireddi, S. V., Skivington, K., Leyland, A. H., Hunt, K., & Mercer, S. W. (2017) · BMC Medicine · doi:10.1186/s12916-017-0913-6 · Cited by 169
Comparing measures of multimorbidity to predict outcomes in primary care: a cross sectional study
Brilleman, S. L., & Salisbury, C. (2012) · Family Practice · doi:10.1093/fampra/cms060 · Cited by 169
Olaya, B., Moneta, M. V., Caballero, F. F., Tyrovolas, S., Bayes‐Marin, I., Ayuso‐Mateos, J. L., & Haro, J. M. (2017) · BMC Geriatrics · doi:10.1186/s12877-017-0586-1 · Cited by 167
“Counting the number of diseases has been a commonly used method [7, 8] but results could be affected by the number of chronic conditions * Correspondence: beatriz.”
MethodSakib, M. N., Shooshtari, S., John, P. S., & Menec, V. H. (2019) · BMC Public Health · doi:10.1186/s12889-019-6567-x · Cited by 170
Schram, M. T., Frijters, D. H. M., van de Lisdonk, E. H., Ploemacher, J., de Craen, A. J. M., de Waal, M. W. M., van Rooij, F. J. A., Heeringa, J., Albert Hofman, D., Deeg, D. J. H., et al. (2008) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2007.11.021 · Cited by 168
“Fourth, medical records, which are considered to be the best way to collect information on medical conditions [1], were used in most settings to determine the presence of a condition, ensuring a valid diagnosis of chronic conditions.”
Patients with Complex Chronic Diseases: Perspectives on Supporting Self-Management
Sevick, M. A., Trauth, J. M., Ling, B. S., Anderson, R. T., Piatt, G., Kilbourne, A. M., & Goodman, R. M. (2007) · Journal of General Internal Medicine · doi:10.1007/s11606-007-0316-z · Cited by 174
The companion dog as a model for human aging and mortality
Hoffman, J. M., Creevy, K. E., Franks, A. M., O'Neill, D. G., & Promislow, D. (2018) · Aging Cell · doi:10.1111/acel.12737 · Cited by 172
Mavaddat, N., Valderas, J. M., van der Linde, R. M., Khaw, K., & Kinmonth, A. L. (2014) · BMC Family Practice · doi:10.1186/s12875-014-0185-6 · Cited by 165
“approximating to 80% among those over 80 years [2-5].”
Dale, W., Hemmerich, J. A., Kamm, A. M., Posner, M. C., Matthews, J. B., Rothman, R., Palakodeti, A., & Roggin, K. K. (2013) · Annals of Surgery · doi:10.1097/sla.0000000000000226 · Cited by 159
“Geriatric assessment included the following specific testing, 4 (of 5) components of Fried’s frailty7: (1) self-reported unintentional weight loss of 10 lb or more in the previous 12 months; (2) height-adjusted slow gait speed; (3) muscular weakness as measured by a gender-adjusted grip strength pressure on a hand dyn…”
MethodWang, H., Beyer, M., Gensichen, J. S., & Gerlach, F. M. (2008) · BMC Public Health · doi:10.1186/1471-2458-8-246 · Cited by 155
“Even if a substantial percentage of chronically ill patients suffers from more than one chronic condition, or multimorbidity in this setting [9,10], a small number of studies focused on the relationship between multimorbidity and HRQoL [11], or the combined effects of pairs of chronic diseases on the HRQoL [8,12].”
BackgroundPrazeres, F., & Santiago, L. M. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-009287 · Cited by 168
“More than half of the study participants had three or more chronic health problems, which is a common prevalence found in developed countries.(3) 33 These findings suggest that Portuguese GPs are likely to struggle with increasingly daily practice concerns, since they will face many challenges regarding the Table 5 Ch…”
BackgroundResultInfluentialLoza, E., Jover, J. Á., Rodríguez‐Rodríguez, L., & Carmona, L. (2008) · Seminars in Arthritis and Rheumatism · doi:10.1016/j.semarthrit.2008.01.004 · Cited by 154
“632 (70) 377 (42) 224 (33) 52 (6) 450 (70) 350 (55) 171 (37) 123 (19) 263 (78) 233 (69) 97 (41) 103 (31) 144 (77) 154 (82) 51 (41) 80 (43) 65 (76) 74 (86) 34 (59) 51 (59) 20 (71) 24 (86) 7 (37) 15 (54) 8 (80) 10 (100) 3 (33) 8 (80) 2 (100) 2 (100) 1 (50) 1 (50)”
BackgroundMethodInfluentialCONSORT extension for reporting N-of-1 trials (CENT) 2015: Explanation and elaboration
Shamseer, L., Sampson, M., Bukutu, C., Schmid, C. H., Nikles, J., Tate, R. L., Johnston, B. C., Zucker, D. R., Shadish, W. R., Kravitz, R. L., et al. (2015) · BMJ · doi:10.1136/bmj.h1793 · Cited by 156
Metadata
- Authors
- Fortin, M.
- Affiliations
- Université de Sherbrooke (CA)
- Corresponding author
- Fortin, M.
- ORCID
- Fortin, M.
- Venue
- The Annals of Family Medicine
- Publisher
- Annals of Family Medicine
- Published
- 2005-05-01
- Volume
- 3
- Issue
- 3
- Pages
- 223-228
- ISSN
- 1544-1709 (ISSN-L)
- 1544-1717
- PMC
- PMC1466875
- OpenAlex
- W2133526648
- Cited by
- 987
- References
- 22
- Citations by year
- 2026: 14 · 2025: 21 · 2024: 32 · 2023: 47 · 2022: 52 · 2021: 67 · 2020: 54 · 2019: 66 · 2018: 55 · 2017: 69 · 2016: 59 · 2015: 71 · 2014: 66 · 2013: 75 · 2012: 67
- FWCI
- 14.34
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- The Annals of Family Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- multimorbidity, chronic disease, Cumulative Illness Rating Scale, disease severity, prevalence, general practice, primary care patients, age differences, sex differences
- MeSH terms
- Family Practice, Female, Humans, Male, Middle Aged, Comorbidity, Prevalence
About these checks
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